Carcinoma of the jejunum with multideposit peritoneal seeding, resection and intraperitoneal chemotherapy / Carcinoma del yeyuno con siembra peritoneal – depósito múltiple resección y quimioterapia intraperitoneal

Jejunal adenocarcinoma is rare, often presenting late with widespread intraperitoneal disease. Intraperitoneal chemotherapy (IPC) has been shown in non-randomized studies to improve the survival of patients presenting with intraperitoneal metastases from carcinoma of the colon, appendix and stomach and in primary peritoneal malignancies including mesothelioma and pseudomyxoma peritonei, providing that adequate operative cytoreduction can be performed. A case is presented of obstructive jejunal adenocarcinoma in which 19 intraperitoneal deposits were excised. The patient was treated successfully with immediate postoperative IPC followed by systemic chemotherapy. This condition is reviewed along with the rationale for IPC.

El adenocarcinoma del yeyuno es raro, presentándose a menudo de forma tardía con enfermedad intraperitoneal extensa. Estudios no randomizados han demostrado que la quimioterapia intraperitoneal (QIP) mejora la supervivencia de pacientes que presentan metástasis intraperitoneal del carcinoma de colon, apéndice y estómago, así como en malignidades peritoneales primarias, incluyendo el mesotelioma y el pseudomixoma peritoneal, siempre que se realice una adecuada citoreducción quirúrgica. Se presenta un caso de adenocarcinoma yeyunal obstructivo en el que se extirparon 19 depósitos del intraperitoneal, tratándose inmediatamente al paciente exitosamente con quimioterapia intraperitoneal postoperatoria, seguida de quimioterapia sistémica. Se examina esta condición junto con las razones para practicar la QIP.

Human external ophthalmomyiasis occurring in Barbados

Human infection with the sheep nasal botfly Oestrus ovis occurs sporadically. In most cases, there is a history of a strike in the eye by the adult fly. Human O. ovis has been reported rarely from the Americas. We report the first case of O. ovis infection in the Caribbean region, which occurred in an urban area of Barbados. The patient responded to removal of the larvae from the conjunctiva and symptomatic treatment

Leiomyosarcoma of the rectum. A report of two cases and review of the literature

Rectal leiomyosarcoma is rare. It is frequently treated by abdominoperineal resection. The role of adjuvant therapy is unclear. Two cases of rectal leiomyosarcoma are presented. Pre-operative endorectal ultrasound predicted submucosal invasion in one case treated by low restorative resection and muscularis propria infiltration in the other managed with abdominoperineal resection. In both cases, ultrasound suggested malignant characteristics as evident by heterogeneous cystic spaces, irregular outline, large size and echogenic foci. Histology was CD34 negative and desmin, alpha-smooth muscle actin and HHF-35 positive, distinguishing these tumours from gastrointestinal stromal tumours. Rectal leiomyosarcoma may be successfully treated by restorative resection and pre-operative ultrasound is useful in assisting this surgical decision by defining malignant features of the tumour. Histopathological characteristics predictive of poor prognosis include high mitotic activity, intratumoural necrosis and tumour size

Analysis of cervico-vaginal (Papanicolaou) smears, in girls 18 years and under

This study was conducted retrospectively at the Queen Elizabeth Hospital and a private laboratory in Barbados to determine the types of epithelial abnormalities in cervico-vaginal Papanicolaou (Pap)-stained smears, and their clinical implications in Barbadian girls, 18 years and under, during the five-year period January 1995 to December 1999. Two hundred and sixty-five Pap smears from 236 patients were examined and the gynaecological history, initial and repeat Pap smear diagnoses, and histology reports of these patients were analyzed. Of the 236 first-visit smears, 94 (39.8) were abnormal with 36 (15.3) displaying cytologic features of squamous intra-epithelial lesions (SIL), (33 low grade and 3 high grade). A diagnosis of atypical squamous cells of undetermined significance (ASCUS) was reported in the remaining 58 (24.5) abnormal smears, of which 35 (60.3) were suspected to be related to human papillomavirus (HPV) infection. Twenty-two (23.4) of these 94 patients, who had abnormal smears of either ASCUS or low grade squamous intra-epithelial lesions (LSIL) were re-evaluated within six to twelve months of the initial abnormal Pap smear diagnosis. Eight of these 22 patients (36.4) had histological diagnosis of LSIL inclusive of cervical intra-epithelial neoplasia grade 1 (CIN 1) and condylomata. High-risk HPV DNA types were detected in two of these eight patients (25). The study confirms that sexually active teenage girls are at risk of developing SIL and high-risk HPV infection. Screening of sexually active teenaged girls by Pap smears followed by other appropriate investigative procedures is recommended.

Appendicitis complicating pregnancy.

Abdominal pain is a common symptom in pregnancy. Its etiology is diverse and diagnosis often poses a problem. Inflammatory disorders of extra-uterine origin such as appendicitis should always be considered as a possible cause. Three cases of appendicitis complicating pregnancy managed at the Queen Elizabeth Hospital, Barbados during the year 1993 are documented. Two presented in the antenatal period and the third postpartum. The clinical manifestations and the difficulties encountered in diagnosis are emphasised.

Haemophagocytic syndrome

Two fatal cases of haemophagocytic syndrome diagnosed on the basis of autopsy findings at the Queen Elizabeth Hospital, Barbados, are presented. They were both young patients, a male 20 years of age and a female 28 years of age, with common clinical features of severe constitutional symptoms, pharyngeal haemorrhages, pancytopenia, and fever. The female patient had elevated titres to herpes simplex virus indicative of recent infection as well as postmortem evidence of overwhelming mixed bacteria sepsis. In both cases, histopathological studies showed lymphoid depletion and histiocytes displaying haemophagocytosis.

Membranous glomerulonephritis and the nephrotic syndrome in a patient with Landry-Guillain-Barré-Strohl syndrome

Membranous glomerulonephritis and the nephrotic syndrome concurrent with the Miller-Fisher variant of the Landry-Guillain-Barré-Strohl syndrome (LGBS), acute post-infective polyneuritis, is reported in a 49-year-old man. The onset of heavy proteinuria coincided with the development of the neurological disturbance. While immunosuppressive therapy appeared to hasten improvemente in the neurological disease, no such improvemente occurred in the glomerulopathy

Coexistence of Porphyria cutanea tarda and systemic lupus erythematosus

The association of porphyria cutanea tarda with a well-documented case of systemic of systemic lupus erythematosus is reported. Renal histopathology is presented. Both conditions have been quiescent during the past year of follow-up

A clinicopathological study of granuloma inguinale in Barbados

The clinicopathological features of fifteen cases of granuloma inguinale diagnosed over a six-year period (1980-1985) are reported. The biopsy sites included cervix uteri, penis, vulva, perineum, anus, endometrium and vaginal wall, in decreassisng order of frequency. The incidence was roughly equal in both sexes with an age range of 16-78 years. In females, the msot frequent clinical diagnosis was carcinoma. The findings indicate that the clinical and histopatological diagnosis of granuloma inguinale entails a high degree of suspcion in a community where the disease in uncommon

Autopsy experience in Barbados

Although there is world-wide concern about the decrase in autopsy srates, to the authors' knowledge, the rates in Barbados have never been documented. The calculation of the non-coroner's autopsy rates and concordance score, and the possible value of the autopsies performed at the Queen Elizabeth Hospital constitute this paper

Pulmonary teratoma

Intrapulmonary teratoma is reported in a n 11-year-old girl. The tumour is remarkable for its larfe siza, since it occupied the entire right hemithorax. The presence of immature elements suggests that it is potentially malignant. However, complete surgical excision appears to have effected a cure at 5 years follow-up. This is the 14th such case to be recorded in the English literature